emt322632 Posted March 1, 2009 Posted March 1, 2009 I have been thinking about this call since it happened and now it's really starting to bug me, so I would like input from the rest of you as to how you would have handled this call... Called to the scene of a MVA, dispatch says that an off duty officer believes that a possible heart attack is the reason for the accident. We got on scene to find in vehicle 1 an elderly man who is extremely aggitated, complains of no injuries, and confirms that he remembers the accident. Vehicle 1 has airbag deployment. Vehicle 2 has two passangers who are out walking around and are refusing all treatments and transportation. SO back to vehicle 1.... The patient tells the fire department that he remembers the accident but shortly after tells the police that he does not. When questioned by EMS about remembering the accident, he says that he doesn not remember. After the fire department does their evaluation and checks the pts glucose level, they get a reading of 49. The patient decides to go to the hospital, I told my partner, who then passed on to fire, that the patient needed to be c spined due to mechanism and airbag deployment. The paramedic from the fire department then told us the they were not going to c spine the patient because the patient was not complaining of any neck or back pain. She then questioned the fire medic about not c spining even though there was airbag deployment. The fire medic replies with "Airbag deployment doesn't mean anything because they go off at 20 mph as well as higher speeds. It's not important." So again, my question to you, Would you have done c spine on this patient or not and why? I feel that it should have been done but even in my own department I'm getting different opinions. I'd immobilize based on the information I have, level of consciousness being the big thing here. I'd like more information though, there isn't really alot there to go by....
Dustdevil Posted March 1, 2009 Posted March 1, 2009 If the EMT decides not to backboard he is making the statement that the patients spine has been cleared of any injury. Good point. And we should probably clearly delineate this discussion with two separate standards: 1. What an EMT should do. 2. What an educated medical professional should do.
cynical_as_hell Posted March 2, 2009 Author Posted March 2, 2009 I appreciate everyones comments and ideas. They have been very helpful. The reason why I had so much concern with this call and rather to c spine or not is due to a call awhile back. It was a rollover on the highway. The female pt that we had was not complaining of any neck or back pain. Her concern was the tooth that she broke during the roll. We went ahead and cspined her anyway, only to find out later that she had a fractured neck, but just couldnt feel it. Once again, thank you to everyone for your comments
ERDoc Posted March 3, 2009 Posted March 3, 2009 Just remember, not all broken necks are a big deal. It all depends on what is broken. There are plenty of stable neck fxs.
jwraider Posted March 4, 2009 Posted March 4, 2009 If he's unreliable he gets a backboard as much as that might suck for him and the FD on scene. In my county a +LOC buys a code2 trauma activation (a few less MDs show up in the room) and it would be fairly awkward to show up and not have the PT cspined. I'm not saying that's always a good reason to use a treatment but that's how it would go here. I wonder if raising his sugar would change things? Would anyone give him d50 on scene? If he suddenly recollected everything and became more reliable could you base treatment on the new story? If he was altered due to sugar at the time of the accident who knows what he missed.
rock_shoes Posted March 4, 2009 Posted March 4, 2009 Potential mechanism + Poor historian = Spinal precations. Had the patient been a reliable historian without head, neck or back pain (proximal to the spine) in a low speed MVI, spinal precautions most likely wouldn't be neccessary.
Jeepluv77 Posted March 6, 2009 Posted March 6, 2009 In my course, we have been taught to c spine in any trauma call. That some can be ruled out but not an mvc, especially with airbag deployment. Even if the pt denies neck/back pain as the adrenaline surge from the crash may mask the pain. I was actually given a scenario like this a couple weeks ago, with pt walking. I took c spine and used a standing backboard. Pt was a & o X3 but I remembered week 1 of my basic training where they said 100+ times c.y.a. so I did. Turns out the scenario called for the pt to be paralyzed from the neck if c spine wasn't used and/or if pt was allowed to sit down. So yeah, I'd use it. If for no other reason than covering my a.
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